系统评价与荟萃分析:幽门螺杆菌感染与糖尿病病人的血糖控制

【作者】 戴伊宁； 余伟来； 朱华佗； 丁洁霞； 虞朝晖； 厉有名；

【机构】 浙江大学医学院附属第一医院消化内科；

【摘要】 Background:Infection with Helicobacter pylori(H.Pylori)has been suggested to play a pathogenic role in diabetes mellitus.The association between H.Pylori and glycemic control in diabetics is controversial.Objectives:Systematic review and meta-analysis to investigate whether H.Pylori infection is associated with glycemic control in patients of diabetes mellitus and whether hyperglycemia in diabetics are modified by eradication of H.Pylori.Methods:We searched PubMed,the Cochrane Library,the Chinese Biomedicine Web Base and Chinese scientific journals’databases from inception to June 2014.Studies examining the association between H.Pylori prevalence and glycemic control and/or the effect of eradication treatment on glycemic control in diabetic humans were eligible for inclusion.Results:20 publications were selected.A meta-analysis of 11 studies with 513diabetics showed a significantly lower glycosylated hemoglobin(HbA1c)level in H.Pylori negative participants than H.Pylori positives[weighted mean difference(WMD)(95%confidence intervals(CI))=0.43(0.07,0.79),p=0.02].In children and adolescents with type 1 diabetes mellitus(T1DM)subgroup,there was positive association between H.Pylori infection and HbAlc level[WMD(95%CI)=0.35(0.05,0.64),p=0.02]while no difference was seen in type 2diabetes mellitus(T2DM)subgroup[WMD(95%CI)=0.51(-0.63,1.65),p=0.38].Meanwhile,a meta-analysis of 6studies with 325 T2DM participants showed significant difference for fasting plasma glucose(FPG)level in H.Pylori positive and negative participants[WMD(95%CI)=1.20(0.17,2.23),p=0.02].However,studies involving T2DM patients were not homogeneous.Eradication of H.Pylori seemed not to improve glycemic control of T2DM patients in a 3-month follow-up[HbA1c decrease:WMD(95%CI)=-0.03(-0.14,0.08),p=0.57;FPG decrease:WMD(95%CI)=-0.06(-0.36,0.23),p=0.68].Glycemic control was significantly better in T1DM patients who were not re-infected compared to those re-infected[HbA1c:WMD(95%CI)=0.72(0.32,1.13),p=0.0005].Conclusion:H.Pylori infection and re-infection is associated with poorer glycemic control in T1DM patients.For T2DM patients,further studies are needed.Eradication of H.Pylori may not improve glycemic control in diabetic patients in a short-term follow-up and further studies are needed to confirm the long-term effect of H.Pylori eradication on glycemic control in diabetics.更多还原

【Abstract】 Background:Infection with Helicobacter pylori(H.Pylori) has been suggested to play a pathogenic role in diabetes mellitus.The association between H.Pylori and glycemic control in diabetics is controversial.Objectives:Systematic review and meta-analysis to investigate whether H.Pylori infection is associated with glycemic control in patients of diabetes mellitus and whether hyperglycemia in diabetics are modified by eradication of H.Pylori.Methods:We searched PubMed,the Cochrane Library,the Chinese Biomedicine Web Base and Chinese scientific journals’ databases from inception to June 2014.Studies examining the association between H.Pylori prevalence and glycemic control and/or the effect of eradication treatment on glycemic control in diabetic humans were eligible for inclusion.Results:20 publications were selected.A meta-analysis of 11 studies with 513 diabetics showed a significantly lower glycosylated hemoglobin(HbAlc) level in H.Pylori negative participants than H.Pylori positives[weighted mean difference(WMD)(95%confidence intervals(CI)) = 0.43(0.07,0.79),p=0.02].In children and adolescents with type 1 diabetes mellitus(T1DM) subgroup,there was positive association between H.Pylori infection and HbAlc level[WMD(95%CI) = 0.35(0.05,0.64),p=0.02]while no difference was seen in type 2diabetes mellitus(T2DM) subgroup[WMD(95%CI) = 0.51(-0.63,1.65),p=0.38].Meanwhile,a meta-analysis of 6studies with 325 T2 DM participants showed significant difference for fasting plasma glucose(FPG) level in H.Pylori positive and negative participants[WMD(95%CI) = 1.20(0.17,2.23),p=0.02].However,studies involving T2 DM patients were not homogeneous.Eradication of H.Pylori seemed not to improve glycemic control of T2 DM patients in a 3-month follow-up[HbAlc decrease:WMD(95%CI) =-0.03(-0.14,0.08),p=0.57;FPG decrease:WMD(95%CI)=-0.06(-0.36,0.23),p=0.68].Glycemic control was significantly better in TIDM patients who were not re-infected compared to those re-infected[HbAlc:WMD(95%CI) = 0.72(0.32,1.13),p=0.0005].Conclusion:H.Pylori infection and re-infection is associated with poorer glycemic control in TIDM patients.For T2 DM patients,further studies are needed.Eradication of H.Pylori may not improve glycemic control in diabetic patients in a short-term follow-up and further studies are needed to confirm the long-term effect of H.Pylori eradication on glycemic control in diabetics.更多还原